Bayada Home Health Care Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $465.57 per claim for T1002 (RN services, per 15 minutes), which is 12.4× the national median of $37.42.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $421.23 per claim for T1003 (LPN/LVN services, per 15 minutes) — 17.4× the national median of $24.24.
Bills $465.57 per claim for T1002 (RN services, per 15 minutes) — 12.4× the national median of $37.42.
Bills $438.92 per claim for S9123 (Nursing care, in the home, by RN, per 15 minutes) — 3.5× the national median of $124.86.
This is a statistical summary, not an accusation. See our methodology.
Compared to Home Health Peers
Total spending distribution among 322 providers in this specialty
This provider's total spending of $269.7M is at the 75th percentile among 322 Home Health providers.
Total Paid
$269.7M
$269,654,252
Total Claims
637K
Beneficiaries
42K
15.2 claims/patient
Avg Cost/Claim
$423
#297 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Bayada Home Health Care Inc. is a Home Health provider based in Toms River, NJ. From the 2018–2024 period, this provider received $269.7M in Medicaid payments across 637K claims.
Why This Matters
This provider received $269.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 33,706 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 6 distinct procedure codes. The top code (T1003 (LPN/LVN services, per 15 minutes)) accounts for 47% of total spending.
LPN/LVN services, per 15 minutes
$126.4M
300K claims · 46.9%
RN services, per 15 minutes
$62.4M
134K claims · 23.1%
$53.1M
139K claims
$382.94
$400.25
Nursing care, in the home; per hour
$53.1M
139K claims · 19.7%
$27.7M
63K claims
$438.92
$124.86
Nursing care, in the home, by RN, per 15 minutes
$27.7M
63K claims · 10.3%
Personal care services, per 15 min
$82K
1K claims · 0.0%
$32K
181 claims
$175.00
$81.30
Assessment of home, physical & family environments
$32K
181 claims · 0.0%
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